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Unit Leader’s and Instructor’s Risk Management Steps for Preventing Cold Casualties

Presenter’s NamePresenter’s Command

Local Contact Information

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Unit Leader's and Instructor's Risk Management Steps for Preventing Cold Casualties – 8 Pages

Download from:

http://chppm-www.apgea.army.mil/coldinjury

Material Needed for this Presentation

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Risk Management is the Army's principle risk-reduction process to protect the force. Our goal is to make risk management a routine part of planning and executing operational missions." - Chief of Staff, Army, July 1995

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Possible Outcomes of inadequate climatic cold management:

Chilblain (due to bare skin exposed to cold, humid air)

Immersion Foot (Trench Foot) (due to wet feet)

Frostbite (freezing of tissue and body parts)

Hypothermia (whole body temperature dangerously low)

Dehydration

Snow Blindness

Carbon Monoxide Poisoning

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Risk Management is the Process of Identifying and Controlling Hazards to Protect the Force

Risk Management Steps1. Identify Hazards2. Assess Hazards3. Develop and Control Hazards4. Implement Controls5. Supervise and Evaluate

Also See Army Field Manual:FM 100-14

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Identify HazardsCold (temperature 40º F and below)

Wet (rain, snow, ice, humidity) or wet clothes

Wind (wind speed 5 mph and higher)

Lack of adequate shelter/clothes

Lack of provisions/Water

• Previous cold injuries or other significant injuries

• Use of tobacco/nicotine or alcohol

• Skipping meals/poor nutrition• Low activity • Fatigue/sleep deprivation• Little experience/training in

cold weather• Cold casualties in the previous

2-3 days

Other Risk Factors include:

If any of the above conditions exist, the risk of a cold weather injury may be increased; follow the Risk Management steps.

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Follow Wind Chill Chart to Determine the Danger Level (see following pages for the chart)

Do individuals have adequate shelter/clothing?

Are clothes clean without stains, holes or blemishes (which could decrease heat retaining function)?

Have meals been consumed?

Are meals warm?

Are there other circumstances?

Is there contact with bare metal or fuel/POL (petroleum, oils or lubricants)?

Is the environment wet? Contact with wet materials or wet ground?

Can solider move around to keep warm?

Are feet dry and warm?

Is the soldier with a buddy who can assist/watch over to prevent cold injures?

Assess Hazards

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Assess Hazards continued

The wind chill index gives the equivalent temperature of the cooling power of wind on exposed flesh.

Any movement of air has the same effect as wind (running, riding in open vehicles, or helicopter downwash).

Any dry clothing (mittens, scarves, masks) or material which reduces wind exposure will help protect the covered skin.

Trench foot injuries can occur at any point on the wind chill chart and -

Are much more likely to occur than frostbite at “LITTLE DANGER” wind chill temperatures, especially on extended exercises/missions and/or in wet environments.

Can lead to permanent disability, just like frostbite.

Using Wind chill Chart

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Work Intensity Little Danger Increased Danger Great Danger

High Digging foxhole, running, marching with rucksack, making or breaking bivouac

Increased surveillance by small unit leaders; Black gloves optional - mandatory below 0oF (-18oC);

ECWCS* or equivalent; Mittens with liners; No facial camouflage; Exposed skin covered and kept dry; Rest in warm, sheltered area; Vapor barrier boots below 0oF (-18oC) Provide warming facilities

Postpone non-essential training; Essential tasks only with <15 minute exposure; Work groups of no less than 2; Cover all exposed skin, Provide warming facilities

Low Walking, marching without rucksack, drill and ceremony

Increased surveillance; Cover exposed flesh when possible; Mittens with liner and no facial camouflage below 10oF (-12oC); Full head cover below 0oF (-18oC). Keep skin dry -especially around nose and mouth.

Restrict Non-essential training; 30-40 minute work cycles with frequent supervisory surveillance for essential tasks. See above.

Cancel Outdoor Training

Sedentary Sentry duty, eating, resting, sleeping, clerical work

See above; Full head cover and no facial camouflage below 10oF (-12oC); Cold-weather boots (VB) below 0oF (-18oC); Shorten duty cycles; Provide warming facilities

Postpone non-essential training; 15-20 minute work cycles for essential tasks; Work groups of no less than 2 personnel; No exposed skin

Cancel Outdoor Training

*ECWCS – Extended Cold Weather Clothing System

These guidelines are generalized for worldwide use. Commanders of units with extensive extreme cold-weather training and specialized equipment may opt to use less conservative guidelines.

Wind chill Category: Follow Wind Chill Chart to determine Danger Level

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Control Hazards

When using Cold-Weather Clothing, Remember

Main Points to Stress to Soldiers:

Keep it……... Clean

Avoid………. Overheating

Wear it……. Loose in layers

Keep it …….. Dry

C-O-L-D

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General Guidance for all Cold-Weather Training

Skin: Exposed skin is more likely to develop frostbite, therefore cover skin. Avoid

wet skin (common around the nose and mouth). Inspect hands, feet, face and

ears frequently for signs of frostbite.

Clothing: Soldiers must change into dry clothing at least daily and whenever

clothing becomes wet. Soldiers must wash and dry feet and put on dry socks at

least twice daily.

Nutrition: 4500 calories/day/soldier. Equivalent to 3 meal packets in meal-cold

weather (MCW) or 3-4 MRE’s.

Hydration: 3-6 Liters (canteens)/day/soldier. Warm, sweet drinks are useful for

re-warming.

Camouflage: Obscures detection of cold injuries; consider not using below 32º

F; not recommended below 10°F.

Responsibilities: Soldiers are responsible for preventing individual cold injuries.

Unit NCO’s are responsible for the health and safety of their troops. Cold injury

prevention is a command responsibility.

Control Hazards continued

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Main Points to Stress to Leaders:Follow these Wind Chill Preventive Medicine Measures based on Wind Chill Temperature

30°F and below Alert personnel to the potential for cold injuries

25°F and below Leaders inspect personnel for wear of cold weather clothing. Provide warm-up tents/areas/hot beverages.

0°F and below Leaders inspect personnel for cold injuries. Increase the frequency of guard rotations to warming areas. Discourage smoking.

-10°F and below Initiate the buddy system. Have personnel check each other for cold injuries.

-20°F and below Consider modifying or curtailing all but mission-essential field operations.

NOTE: TRENCH FOOT can occur at any temperature - Always Keep Feet Warm and Dry

Control Hazards continued

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Ensure appropriate clothes and proper wearing of clothes –

Loose and in layers

Clean

Ensure proper boots are worn and are dry

Clothes do not have holes/broken zippers etc.

Hands, fingers and head are covered and protected

Avoid spilling liquids on skin or clothes, liquid stains will reduce clothing’s protective efforts

Change wet/damp clothes ASAP

Keep Body WarmKeep moving

Exercise big muscles (arms, shoulders, trunk, and legs) to keep warm

Avoid alcohol use (alcohol impairs the body’s ability to shiver)

Avoid standing on cold, wet ground

Avoid tobacco products which decrease blood flow to skin

Eat all meals to maintain energy

Drink water and/or warm nonalcoholic fluids to prevent dehydration

Personal Protection

Control Hazards continued

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Protect FeetKeep socks clean and dry

Wash feet daily if possible

Carry extra pairs of socks

Change wet or damps socks ASAP; use foot powder on feet and boots

Avoid tight socks and boots; do not over tighten boot or shoes

Wear overshoes to keep boots dry

Protect HandsWear gloves or mittens or mittens with inserts

Warm hands under clothes if they become numb

Avoid skin contact with snow, fuel or bare metal. Wear proper gloves when handling fuel or bare metal.

Waterproof gloves by treating with waterproofing compounds

Control Hazards continued

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Protect Face and Ears

Cover face and ears with scarf. Wear insulated cap with flaps over ears or balaclava

Warm face and ears by covering them with your hands. Do NOT rub face or ears.

Consider not using face camouflage when wind chill is 32º F or below; not recommended below 10º F

Wear sunscreen

Exercise facial muscles

Protect your Eyes

Wear sunglasses to prevent snow blindness

If sunglasses are not available, protective slit goggles can be made from cutting slits in cardboard (eg. MRE cardboard box).

Control Hazards continued

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Protect Each Other

Watch for signs of frostbite and other cold weather injuries in your buddy

Ask about and assist with re-warming of feet, hand, ears or face

Prevent Carbon Monoxide Poisoning

Use only Army approved heaters in sleeping areas

Do not sleep near exhaust of a vehicle while vehicle is running

Do not sleep in enclosed area where an open fire is burning

Control Hazards continued

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Leadership ControlsDiscontinue/limit activities/exercise during very cold weather (see chart page 2)

Use covered vehicles for troop transport

Have warming tents available

Have warm food and drink on hand

Control Hazards continued

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Facility ControlsUse only Army authorized heaters. (ie: no kerosene or propane heaters)

Ensure heaters are in working order and adequately ventilated

Ensure integrity of shelters for maximum protection from the cold

Control Hazards continued

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Implement Controls

Identified controls are in place

Controls are integrated into SOPs

•Educate soldiers of hazards and controls (including newly arrived soldiers)

• Implement buddy system to check clothes/personal protection

Decision to accept risk is made at appropriate level

Buddy System to check each other

Self Checks

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Supervise and EvaluateEnsure all soldiers are educated about prevention, recognition and treatment of cold weather injuries

Delegate responsibilities to ensure control measures have been implemented

Monitor adequacy/progress of implementation of control measures

Do frequent spot checks of clothes, personal protection and hydration

Record and monitor indicators of increasing cold risks, for example:

• Increasing number of cold weather injuries

• Increased complaints/comments about cold

• Observations of shivering, signs of cold weather injuries

Evaluate current control measures and strategize new or more efficient ways to keep warm and avoid cold injuries

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Cold Weather Casualties and Injuries:

Chilblain (due to bare skin exposed to cold, humid air)

Immersion Foot (Trench Foot) (due to wet feet)

Frostbite (freezing of tissue and body parts)

Hypothermia (whole body temperature dangerously low)

Dehydration

Snow Blindness

Carbon Monoxide Poisoning

Train soldiers on the proper use of cold weather clothing Remember the acronym C-O-L-D when wearing clothing in cold weather(C: Keep it Clean; O: avoid Overdressing; L: wear clothing Loose and in layers; D: keep clothing Dry) Maintain adequate hydration and ensure nutritional requirements are met

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ChilblainCause Symptoms First-Aid Prevention

Repeated exposure of bare skin for prolonged periods from 20°-60°F with high humidity (for those not acclimated to cold weather).

Swollen, red skin (or darkening of the skin in dark-skinned soldiers). Tender, hot skin, usually accompanied by itching.

Warm affected area with direct body heat. Do not massage or rub affected areas. Do not wet the area or rub it with snow or ice. Do not expose affected area to open fire, stove, or any other intense heat source.

Use contact gloves to handle all equipment; never use bare hands to handle equipment, esp. metal. Use approved gloves to handle all fuel and POL* products. In the extreme cold environment, do not remove clothing immediately after heavy exertion (PT); until you are in a warmer location. Never wear cotton clothing in the cold weather environment.

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Immersion foot (trench foot)

Cause Symptoms First-Aid Prevention

Prolonged exposure of feet to wet conditions 32°-60°F. Inactivity and damp socks and boots (or tightly laced boots that impair circulation) speed onset and severity.

Cold, numb feet may progress to hot with shooting pains. Swelling, redness, and bleeding.

If you suspect trench foot, get medical help immediately! Re-warm feet by exposing them to warm air. Do not allow victim to walk on injury Evacuate victim to a medical facility. Do not massage, rub, moisten, or expose affected area to extreme heat.

Keep feet clean and dry; change wet or damp socks as soon as possible. Wet of damp socks should be dried as soon as possible to allow them to be re-used. The inside of Vapor Barrier boots should be wiped dry once per day, or more often as feet sweat. Dry leather boots by stuffing with paper towels.

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FrostbiteCause Symptoms First-Aid Prevention

Freezing of tissue. eg.: fingers, toes, ears, and other facial parts. Exposure to bare skin on metal, extremely cool fuel and POL* wind chill, and tight clothing - particularly boots - can make the problem worse.

Numbness in affected area. Tingling, blistered, swollen, or tender areas. Pale, yellowish, waxy-looking skin (grayish in dark-skinned soldiers). Frozen tissue that feels wooden to the touch.

Frostbite can lead to amputation! Evacuate immediately! Start first-aid immediately. Warm affected area with direct body heat. Do not thaw frozen areas if treatment will be delayed. Do not massage or rub affected areas. Do not wet the area or rub it with snow or ice. Do not expose affected area to open fire, stove, or any other intense heat source.

Use contact gloves to handle all equipment; never use bare hands to handle equipment. Use approved gloves to handle fuel and POL*. Never wear cotton clothing in the cold weather environment. Keep face and ears covered and dry Keep socks clean and dry Avoid tight socks and boots.

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HypothermiaCause Symptoms First-Aid Prevention

Prolonged cold exposure and body-heat loss. May occur at temperatures well above freezing, especially when a person is wet.

Shivering may or may not be present. Drowsiness, mental slowness or lack of coordination. Can progress to unconsciousness, irregular heartbeat, and death.

This is the most serious cold exposure medical emergency and can lead to death! Get the soldier to a medical facility as soon as possible! Even if a victim is cold and is not breathing, never assume someone is dead until determined by medical authorities! Strip off wet clothing and wrap victim in blankets or a sleeping bag. Place another person in sleeping bag as an additional heat source. For the person with unconsciousness and very low heartbeat, minimize handling of the victim so as to not induce a heart attack.

Never wear cotton clothing in the cold weather environment. Anticipate the need for warming areas for soldiers exposed to cold, wet conditions.

 

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DehydrationCause Symptoms First-Aid Prevention

Depletion of body fluids.

Dizziness. Weakness. Blurred vision.

Replace lost water. Water should be sipped, not gulped. Get medical treatment.

At a minimum drink 3-6 quarts of fluid per day.

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Snow BlindnessCause Symptoms First-Aid Prevention

Burning of the cornea of the eye by exposure to intense UV rays of the sun in a snow-covered environment

Pain, red, watery or gritty feeling in the eyes

 

Rest and total darkness; bandage eyes with gauze Evacuate if no improvement within 24 hours

Use sunglasses with side protection in a snow-covered environment. If sunglasses are not available use improvised slit glasses.

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Carbon Monoxide Poisoning

Cause Symptoms First-Aid Prevention

Replacement of oxygen with carbon monoxide in the blood stream caused by burning fuels without proper ventilation

Headache, confusion, dizziness, excessive yawning Cherry red lips and mouth, grayish tint to lips and mouth (in dark skinned individuals)Unconsciousness

Move to fresh air CPR if needed Administer oxygen if available. Evacuate

 

Use only Army approved heaters in sleeping areas and ensure that personnel are properly licensed to operate the heaters Never sleep in running vehicles Always post a fire guard when operating a heater in sleeping areas.

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Cold Weather Injury Products Available (in 2002) from the US Army Center for Health Promotion and Preventive Medicine (CHPPM)

http://chppm-www/apgea.army.mil/coldinjury

Soldier Awareness Poster

Cold Weather Injuries Chart

Risk Management Guide

Cold Weather Injuries Card

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Questions?